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EEG and Trauma, what they don't prepare you for!

One of the most critical things we as neurodiagnostic technicians don't get trained for is Trauma. I think the healthcare industry as a whole over looks the trauma impact on the caregivers and mostly focuses on the family and the patient. While we chose this job to help people, that does not mean we are prepared or even know how to process the trauma we see. I am going to stick with what I know and my personal experiences to share. I am a registered EEG technician. My preference is to work with neonates and trauma patients.

Some may ask "why" if we are talking about trauma and its affects on the tech. The answer for me is simple. I pride myself on knowing the care I deliver in tough situations. For me, it is a matter of knowing how I can care for patients in their most vulnerable times and contribute my best testing to the care team (in some cases this means life or death).

Like many of my colleagues in this field, I was trained on the job. When trauma happened, you just pack it up and do the job. I had mentors who taught me how to jump in and give care. How to coordinate care with the care team and how to treat the patient with kindness and dignity. No one ever taught me how to deal with what I was actually doing and the impact it had on me as a human.

Through the trajectory of my career I have worked, relocated, traveled, taught students and mentored others. I have still not seen the profession teach us how to deal with the human emotions we feel when working with trauma. Or how to create a safe space for ourselves when we find a connection to the patient that has experienced trauma.

Many of us, whether we admit it or not, deal with our emotions privately. Some cry in the break room, others may find solace in the work itself. Some of us try and ignore it as part of the job. While all these these coping mechanisms are a personal choice, I do not feel like we are preparing the future of our healthcare community how to stay mentally healthy through our careers.

My first experience with Trauma as part of the healthcare team was in the ICU. I was a very new technician and the patient was critically ill. The room was full of people rushing about, alarms are sounding everywhere and there I stood, in the doorway, facing a scene I had not been prepared for! I was scared and nervous. Tubes, wires and beeping chaos surrounded me, all while some are glancing at me in the hustle with skeptical glances. Finally a face I recognized, an RT who was in the room dealing with the ventilation machine with relentless alarms blaring. He looked at me with a calm presence and said "Get in here, you are a part of this team!". This gave me the confidence I needed to roll up my proverbial sleeves and take my place in the care team in that room. Afterwards, all I could do was thank him for giving me that courage. I still didn't know how to process the things that were happening to the patient but at least I now was armed with the courage to do my best practice without fear. I went home after my shift feeling conflicted. While I was proud of myself and grateful for that RT, I was sad for what was happening to that patient. I didn't know them, wasn't part of their friend or family circle. Still I was sad. This confused me. I don't always think we feel safe in the medical community to express these feelings out of fear for ridicule. I know at this stage of my career I didn't!

My next impactful traumatic experience was in an ECS case. Now this was not my first ESC case but it definably impacted me in a real way that I did not expect. I was called into the ICU to determine brain death on an overdose case. I walked into the room filled with family and friends, finding myself staring at an absolutely healthy looking middle aged male who was so tall the feet and head were nearly off ether end of the bed. The patient looked healthy, active and tan even under the ICU lights and the glow of the ventilator machine. Everyone was silent and ominous. Per our ACNS Guidelines, we must empty the room of any excess interference when doing this type of test. So, my courage in hand with my tape measure and marker I let the family know they are welcome to stay while I set up the test but they must leave while the test is being preformed. I do not explain "why" in detail, just that having extra bodies in the room can lead to artifact that could obscure the results and I want to get the best test possible. I spoke to the family and the patient as if he could hear me and explained what I was doing. I proceeded with my testing after clearing the room and finding in disbelief that this healthy human in the bed before me is no longer there. I completed my test, and allowed the family back into the room while I thoroughly cleaned all the 10-20 paste up and washed my marks off. After my shift, I went home and excused myself from my family and sat in the sun and cried for the human that had been lost. I don't know why. I didn't know any of them. But something was incredibly sad inside me.

Later that night we met some friends for dinner. While eating, one casually asks me "is it passible to come back from ECS (she did not know the term). I flippantly answered "Nope" and my friend burst into tears. It was her cousin. At the time, she did not know I went home and cried for her cousin, instead she felt I was cruel in my answer. I had no idea that my casual response to a seemingly innocuous question could lead to such pain. Because of HIPAA, I could not explain it to her. I could not and would not breech the privacy of my patient or the family, no matter the relationship to her or her to me. I often wonder if people even know how we suffer for them as silent strangers. Do we need that? I don't think so, but I do feel as though we have the same human rights to feel regardless of the career we choose. This experience made me grow as a technician and as a human. I learned to temper my quick, flippant responses and think before I spoke because we never know how we are impacting the people around us. They say 6 degrees of separation for everyone on the planet and this case brought that thought home for me.

The most recent case that I want to share is a culmination of my personal growth through the trajectory of my career. Up to this point, I had now earned my R.EEG.T and was starting to teach, tutor and mentor other students in their careers as Neurodiagnostic technicians. By this point, I had started to teach that we need to be diligent in our practice. Kind, empathetic and professional within our scope of practice. Teaching others to set aside their feelings in the moment to provide care, but to be sure they care for themselves once their job was over. This case has been the test of my career so far. I was called in to the ICU for a trauma case. MVA with a critical traumatic brain injury. A flatbed semi is rear-ended by a Ford F150 in poor weather conditions. The driver in the F150 was my patient. Pre-op EEG for craniotomy and post op EEG were on my docket. As I was the tech on call, I knew I would go back in as soon as the patient was back in ICU after surgery. So I went home and prepared myself for the worst but was hoping for the best. Once I arrived home, my spouse told me about her childhood friend who's fiancé' was in a horrific accident and they were asking for help to prepare for the worst. I could not share with my spouse because of patient privacy. All I could do was explain that I would be doing his testing. While everyone we knew was flocking to the hospital to support the family and friends, I directed my spouse to the family room and vacated to my office to wait for the call to perform the post-op EEG. I knew I could not meet with the family and still provide care. I wanted to be the one who was entrusted with this testing and didn't want the test integrity or HIPAA questioned. This went on for more than a week. I avoided the family and friends, would not comment and only listened to them as they planned his funeral. Above all, my practice was to provide them the best recording I could deliver to the care team so decisions could be made. I would come home after work and hear all the funeral plans and the horrific list of injuries that I had already known and sit in silence. I would watch every test progress and the prognosis change each day, still holding silent. I watched my screen of squiggly lines and kept this mantra "just keep talking to him". When my spouse or fiends would ask me what I thought, all I could say was "just keep talking to him". Not for any other reason than it was not my place as a professional on the healthcare team to offer any opinion. It is not only against my licensure but also against my beliefs for patient privacy.

My spouse and friends would talk about the progress every day. Read me the Social Media updates. Discuss their opinions and ask me questions. The questions were always "I know you can't tell us but ...?" They would debate his treatment plans and the treatment of the family. All I could say was "just keep talking to him".

With every EEG I did, I would hope in silence for progression in the right way. Looking for signs of life and cognition. With every STAT order and critical changes in those few days, felt like an eternity. The private side of my life was consumed with the grimmest of outlooks. My professional side was looking at the progression. Still, I would not break my silence. I knew the family was facing some very hard decisions for quality of life. That very decision that we all are aware of but never seems that close to our own lives until it's right there happening. Now, I am right in the middle of all these feelings with no reprieve. How do I care for my own feelings when there is no safe space for them. My home and social life are consumed with this tragedy and professional life is consumed with the reality of healthcare. How do we train for that? Where are the CEU's for this training?

It wasn't until they had transferred the patient to an intensive brain injury program out of state that I felt I was able to decompress. I didn't have to sneak through the back door of the ICU anymore, and my social surrounding started to fade into local comings and goings with fewer social media updates. Now, I finally had some space to deal with my feelings. I still could not share because of HIPAA but I could start to care for myself. Part of that caring for myself was to grow as a person and a healthcare professional.

We may not admit it to ourselves or to our colleagues but each traumatic situation leaves an impact on the medical professionals as well. Not all good, not all bad. In my case, I wanted to use my struggles to raise up the next generation in Neurodiagnostics to be empowered when dealing with trauma. I want to share the things I think we all feel or have felt at one point in our careers. To acknowledge what we feel in the proper place and context while still growing our personal and professional practice.

It took me almost 5 years to meet my spouse's childhood friends. Yes he did survive and is thriving. We were able to meet for lunch and share the experience from both sides of the bed. I cannot express my joy at the sight of seeing him and talking to him. Having lunch and sharing stories of his own journey. It was this meeting that inspired me to want to share with my community. I actually did not feel quite better from this traumatic situation until after we met. We had relived it as a healthcare forum here locally as a case study. While I am no longer at that facility, I did get expressed permission from the patient and his spouse to share this with you all.

I will leave you with the final thought, I hope we can uplift and support each other the way we do our patients and their loved ones, because we experience their trauma with them and in many cases more than one trauma a day. Take care of yourselves and others in your community. While we all have stories like these and many more, if you don't put on your own oxygen mask on first, you won't be around to help others.


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